Month: February 2014

My 2013 adventures around the world talking about the benefits of exercise at cancer conferences

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2013 was a big year for me. I managed to present my research involving ovarian cancer patients at 3 conferences, I spoke at 5 different hospitals in Sydney as well as 3 patient support groups. I am 100% happy to put my work aside so I can take these opportunities, as it is very important for patients, clinicians, families, nurses and the general public to be aware of how something as simple as walking can actually help a cancer patient.

The year started off with a trip to Adelaide, Australia for the Flinders Centre for Innovation in Cancer Survivorship conference. This was a great opportunity and and interesting mix. Half of the delegates were medicos (doctors, nurses, allied health staff) whilst the other half were cancer survivors/patients/advocates – So all in all it was a really nice dynamic. This was my first conference presenting this research, so naturally I was a little bit nervous. The main points of the poster above were:

* ovarian cancer patients undergoing chemo were asked to achieve 90+ mins/week of exercise for 12 weeks – They could do it!

* Their sleep improved

* Their fatigue reduced

* Their quality of life increased

* Their muscular strength increased

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I actually got some great exposure from this conference. I had oncologists from around Australia asking me what they should be encouraging their patients to do, and also some amazing cancer survivors telling me of their experiences with trying to remain active. I simply encouraged them, keep up what you are doing and every week try and out-do what you did last week. “A little bit longer in duration, a little bit higher in intensity and you will reap the benefits.”

Next stop – Liverpool, United Kingdom – the home of the Beatles, Liverpool or Everton Football Club (depending who you are speaking to), lack of sun and many a pub.

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The European Society of Gynaecological Oncology Conference. What an experience this was. Over 3000 medical folk, a handful of Australians, in which I did not know any and a lot of great research presentations from top European doctors. This conference was interesting for me, as the majority of topics were related to drug or surgical administration, and minimal on complementary medicines such as exercise, diet or psychological interventions – which are all extremely valuable to the well-being of each patient. This was a good thing for me, as my work was more unique, and again I had decent interest from people around the world. So many European doctors were telling me they didnt have the funds to employ an exercise physiologist or a physiotherapist in their hospitals. My response – educate the patient on the importance on remaining active during and after treatment. They will listen to you. That is it, a couple of sentences will provide encouragement.

Image(my abstract at the bottom underneath all the very complex medical trials)

In this conference I spoke about the relationship between physical activity and sleep quality for ovarian cancer patients undergoing chemo. Firstly, they dont sleep well at all. So i monitored them with this high tech GPS device to track their sleep quality for a week. Turns out, of the participants who were more active than the others, they actually slept better. This is important because more sleep -> less fatigue -> more energy -> less anxiety -> higher quality of life = good news.

However, it was a great experience and a lot of hard work. Hard work means hard play – so naturally, being on the other side of the world, I thought it was only fair I could have some down time

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Image(me enjoying delicious Manchester pub lunch, visiting the Cavern in Liverpool – where Beatles played their gigs, giving a fake press conference at Arsenal’s Emirates Stadium and seeing Arsenal play vs Chrystal Palace at Selhurst Park, London).

Back on a long plane ride to Sydney (26 hrs) and straight to Adelaide again for the Clinical Oncology Society of Australia conference.

ImageNow this picture was taken of me in front of my poster during the networking function, in which a couple of glasses of wine were consumed compounded with my jetlag from the UK and I guess I was just being silly.

Nonetheless, this was another great conference for me. This time I spoke about what were the reasons holding patients back from exercising – the barriers. In a nutshell, the main reason for not exercising for fatigue. Now, I get that. But when there is evidence showing engaging in exercise will reduce your fatigue, you would wish to give it a go. The patients who were exercising more in this study, reported less fatigue again. A trend appears to be going on. Other reasons for not exercising was that it was not a priority and procrastination was an issue. If you have read my previous articles showing exercise can increase life expectancy, reduce recurrence risk and improve countless symptoms, I think it IS a priority and I dont think procrastination should be a word in your vocabulary anymore.

These were amazing experiences. Now i set up 2014 with a more meetings, conferences and patient support group talks ahead of me, I am full of excitement for what this year has to come. If I have an audience of 1 person or 150 people, it does not matter to me, as long as the message gets through. You can do it, one step at a time.

David

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The Benefits of Exercise during Radiotherapy for Breast Cancer

After receiving an overwhelming response for my recent post “Exercise to increase overall survival and reduce disease recurrence”, I was able to get in touch with some amazing people who were implementing positive healthy behaviours into their journey.

I would like to commend one poster, who during radiotherapy, despite having leg muscle impairments, was exercising 30-45 minutes daily, doing weights, yoga, physio and meditation – and feeling great!! Great inspiration. She gave me the idea to speak about exercise during radiotherapy (RT).

Common side-effects of RT are fatigue, pain, shoulder instability, cardiac damage and reduced quality of life. The majority of these I have previously mentioned will be improved by engaging in aerobic physical activity. An article published in 2008 by Ji Hyi Hwang in South Korea worked with breast cancer patients after surgery, who were about to commence RT.

Protocol:

Exercise consisted of 3x 50 minute sessions a week for 5 weeks

Each 50 minute session consisted of:

10 minute warm up

30 minutes exercise (treadmill walking, cycling, strength exercises, shoulder stretching)

10 minute cool down (relaxation)

The main results were as follows:

 

Exercise RT

 

On each figure, the left bars indicate the non-exercising control groups – who experienced reduced quality of life, increased fatigue and worse pain

The right bars indicate the exercising group – who experienced IMPROVED quality of life, IMPROVED fatigue and HIGHER pain threshold. This is a two-fold swing right here. Furthermore, the exercising group had better upper arm flexibility – which is vital to be able to continue doing normal activities at home – driving, washing, going to shops, lifting things etc!

Here is the link below to the article:

http://synapse.koreamed.org/Synapse/Data/PDFData/0069YMJ/ymj-49-443.pdf

If you or somebody you know is undergoing or about to undergo radiotherapy, provide support, ask them to go for a walk with you. Go at their pace, doesnt matter how fast, it is better than nothing. Once confident and building endurance, then you can start to go faster and you will start embracing some of the great benefits. Walking is safe and does not require supervision. If you wish to have a weights program prescribed to you, consider speaking with your physiotherapist, or certified exercise physiologist

As always, please comment, ask questions, go for a walk, share this blog with a friend or family member, follow me and stay positive.

David

Your exercise physiologist – Exercise Oncology Australia

Exercise to increase overall survival and reduce disease recurrence

I’d like to speak today about a great article published in 2006 in the Journal of Clinical Oncology, one of the top ranking oncology journals titled “Impact of Physical Activity on Cancer Recurrence and Survival in Patients With Stage III Colon Cancer” by Jeffery Meyerhardt. The study used patients with Stage 3 Colon cancer 6 months after chemotherapy treatment.

The study first asked patients how much activity they were engaging in per week. Each type of activity has an intensity, where a higher intensity allows for more energy exertion. The terminology used is called a MET or metabolic equivalent – so when we are resting, we exert 1 MET, brisk-walking is 4.5 METs or swimming is 7 METs.   I’ve included a table from the article below:

MET exercise intensities

As I’ve mentioned previously, “more is better than less and some is better than none”. This is a good place to start. Once you can get into a rhythm of regular exercise, it is time to train for longer and add in some challenging sessions.

What this study found was really interesting, and is a reason why there is more research in exercise oncology studies. Patients who engaged in at least 18 MET-hours/week (approx 6 hrs of normal pace walking or 1.5 hrs of running or 2.5 hrs of tennis per week) had a 47% improvement on disease-free survival than inactive patients. This is HUGE! The table below shows the survival rates by different levels of activity

reduced mortality

Personally, I think this is really ground breaking, with more and more oncologists now wishing to have their patients participating in exercise studies. There is emerging hard evidence, this isnt just fluff and games. Get out there and start to move, walk, shake that body. One step at a time. You can do it.

Here is the link to the article:

http://jco.ascopubs.org/content/24/22/3535.full.pdf+html

As always, please feel free to comment, share, like, follow me, ask questions or just go out for a long walk after reading this. 

Exercising during chemotherapy – you can do it!!

From what i’ve seen and heard from patients, chemotherapy is one of the toughest parts of cancer treatment. 6 months of hospital visits, sleepless nights, nausea, fatigue and uncertainty. Then walks into the clinic David, the Exercise Physiologist, every week to see if there are any new patients he can ask to come and join his studies..

Every week for all of last year, I would visit 2 hospitals in Sydney, each on two mornings per week to see if there were any patients eligible to recruit into my trials. Women with recurrent ovarian cancer undergoing chemo to be precise. This is a group of patients who’s cancer has returned and spread, requiring higher doses of chemo and as a result, having worse side-effects of treatment. This was the first study to date to include this patient group – so it was very challenging but exciting at the same time to try and assist these patients throughout treatment.

Here are some things we do know during chemotherapy:

* Patients (and their families) tend to  withdraw themselves during chemo (6 months of inactivity!)

* You may become weaker during this time, along with additional side-effects of treatment

* Recent exercise studies have displayed safety, as well as countless psychological and physical benefits

* Reaching recommended physical activity guidelines can decrease your risk of cancer recurrence and all-cause mortality by more than a third!

Back to my recruitment. I would speak with numerous patients about their lifestyles, the majority not doing anything due to excessive fatigue – with nearly all of them not knowing how exercise can help them. I had about a 50% uptake rate, which is about normal for studies such as these, with many women not willing to commit to a 3 month study. However I did not mind, I still provided them with advice and encouragement to walk whenever they can and build up their endurance during chemo.

Now to the ones that did join the study, firstly I did baseline health checks, with most of them having physical and mental function, low muscle strength and excessive fatigue – not surprising. Everyone received a different exercise program tailored to their needs and goals, but started at 90 minutes/week (about 15-20 mins/most days of the week). This would be a combination of aerobic exercise (mainly walking and gym cycling) and resistance training (gym weights and resistance bands). It was not without its challenges for these amazing women. Here is an example week for one:

Monday – walk 20 mins (including hills)

Tuesday – theraband resistance session – 25 mins

Wednesday – chemo day – light morning walk – 15 mins

Thursday – rest day (feeling ill)

Friday – rest day (feeling ill)

Saturday – rest day/light walk 15 mins

Sunday – resistance exercises and walk – 30 mins

No week would really be the same depending on how they responded to the treatment, but i’ll tell you this now, if they hadnt been exercising, they would be feeling a whole lot worse. Im very happy with a week looking like this if possible.

If you’re undergoing chemo – you can do it. Don’t aim for a marathon, set a realistic aim at giving it a go – because you can achieve that. 10 minute walks around the block will assist in alleviating the fatigue and sets a platform to increase this. Some is better than none and more is better than less. The aim is 150 minutes a week of moderate intensity exercise (increased breathing rate). But if you can only achieve half of this amount, that is more than fine, it is a start. You cant progress if you haven’t started. If you havent started your journey, let it start now….one step at a time.

I hope these posts provide support, motivation and guidance. Feel free to ask any questions or comments and again please forward to a friend or family member undergoing the cancer experience.